Abstract

The long-term care (LTC) workforce play a crucial role in the delivery of care and will therefore have an important effect on quality of care. It is important for policy to understand the factors that affect the quality of care in LTC, and to what extent, so as to sustain and improve the quality of social care services, improve workforce retention and ensure that public funds are spent efficiently. There is only limited research evidence on the effect of staffing on the outcomes of those supported by home care. This study looked to assess the economic determinants of home care provider quality in England, in particular concentrating on staffing factors.

Utilising a production of welfare approach, we developed an empirical model to estimate the effects of factors at the provider-level, including staffing, and local area-level on the quality of home care providers. We used data from the Adult Social Care Workforce Data Set for 2016-2018 and matched to this local area data on needs, demand and supply. There were 7,636 home care provider observations across the three waves which was equivalent to one in four providers of home care in England for each year. We estimated random effects linear probability models (OLS) of a binary indicator of home care provider quality, the national regulator's quality rating. Standard errors are clustered at provider level, and we used instrument variables techniques to control for the endogeneity of wage and multiple imputation to address missing data.

We found that direct care staff to service user ratio (positively) and proportion of staff employed on contracts with no minimum hours of work (negatively), significantly affected the likelihood of high quality. We found no effect of wage on the quality rating of a home care provider, which we believe most likely to be due to data quality. We also found competition and sector effects in line with previous literature. These findings were generally robust across a number of specifications.

There are generally very high and consistent staff turnover rates in LTC internationally. The findings of this research confirm that work conditions, such as contract type, are important factors in the quality of care. This could be through the effect this has on employee satisfaction and could also influence turnover intention. It is therefore important that policy considers LTC employment conditions carefully. Further, it is important to ensure that attempts to lower costs in the delivery of LTC through low remuneration and non-guaranteed hours of work do not ultimately lead to greater costs to health and social care systems. There are limitations to this research which include the data quality and that we cannot ascertain the impact that lower quality has on costs, which future research would be required to assess.